Chart(x) E.H.R. 3.0

Measure 4 (eRX) E-Prescribing

e-Prescribing (eRx)
Generate and transmit permissible prescriptions electronically (eRx).
More than 40 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology.
Any EP who writes fewer than 100 prescriptions during the EHR reporting period.

Definition of Terms

Permissible Prescriptions - The concept of only permissible prescriptions refers to the current restrictions established by the Department of Justice on electronic prescribing for controlled substances in Schedule II-V. (The substances can be found at
Any prescription not subject to these restrictions would be permissible.
Prescription - The authorization by an EP to a pharmacist to despense a drug that the pharmacist would not dispense to the patient without such authorization.

Attestation Requirements



  • DENOMINATOR: Number of prescriptions written for drugs requiring a prescription in order to be dispensed other than controlled substances during the EHR reporting period.
  • NUMERATOR: Number of prescriptions in the denominator generated and transmitted electronically.
  • EXCLUSION: EP's who write fewer than 100 prescriptions during the EHR reporting period would be excluded from this requirements. EP's must enter the number of prescriptions written during the EHR reporting period in the Exclusion box to attest exclusion from this requirement.
The resulting percentage must be more than 40 percent in order for an EP to meet this measure.

Additional Information

  • The provider is permitted, but not requireed, to limit th emeasue of this objective to those patients whose records are maintained using certified EHR technology.
  • Authorization for items such as durable medical equipment, or other items and services that may require EP authorization before the patient could receive them, are not included in the definition of prescriptions. These are excluded from the numerator and the denominator of the measure.
  • Instances where patients specifically request a paper prescription may no be excluded from the denominator of this measure. The denominator includes all prescriptions written by the EP during the EHR reporting period.
  • Although the Department of Justice recently published an interim Final Rule that allows the electronic prescribing of controlled substances, these recent guidelines could not be incorporated into the Medicare and Medicaid EHR Incentive Programs. The determination of whether a prescription is a permissible prescription for purposes of this measure should be made based on the guidelines for prescribing Schedule ii-V controlled substances in effect on or before January 13, 2010.
  • EP's cannot receive incentive payments for e-prescribing under both the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) and the Medicare EHR Incentive Program for the same year. However, EP's, can receive payments from both  the MIPPA E-Prescribing Incentive Program and the Medicaid EHR Incentive Program for the same year.
  • Providers can use intermediary networks that convert information from the certified EHR into a computer based fax in order to meet this measure as long as the EP generates an electronic prescription and transmits it electronically using the standards of certified EHR technology to the intermediary network, and this results in the prescription being filled without the need for the provider to communicate the prescription in an alternative manner.
  • Prescriptions transmitted electronically within an organization (the same legal entity) do not need to use the NCPDP standards. However, an EP's EHR must meet all applicable certification criteria and be certified as ahaving the capability of meeting the external transmission requirements of 170.304b. In addition, the EHr that is used to transmit prescriptions within the organization would need to be Certified EHR Technology.
  • EP's should include in the numerator and denominator both types of electronic transmissions (those within and outside the organization) for the measure objective.
  • For purpose of counting prescriptions generated and transmitted electronically, we consider the generation and transmission of prescriptions to occur constructively if the prescriber and dispenser are the same person and/ore are accessing the same record n an integrated EHR to creating an order in a system that is electronically transmitted to an internal pharmacy.

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